Dupuytren’s Disease: Treatment of Nodules or Cords without Contracture
Now you have been properly diagnosed with Dupuytren’s disease because you’ve been to your orthopedic doctor for an evaluation. Luckily, you are in the early stages, and you do not have any contractures to your joints. You can either continue to monitor the hand with the table test, or you can talk to your doctor about treatment options.
In some cases, cortisone can be injected into the painful nodule to provide symptom relief of the tenderness. Possible side effects of repeated cortisone injections include tenderness, depigmentation over the injection site, atrophy at this injection site.
Xiaflex is an injectable medication that aims to break up the cord formation in the hand by dissolving some of the Dupuytren’s tissue. The finger will either be splinted as per your doctor’s recommendation or a home stretching program may be initiated to maintain normal use of the hand and finger. The injection could be repeated if still unable to straighten your finger.
A needle aponeurotomy can be an option for treating the cord in the finger. It’s main goal is to scarify the cord with a thicker gauged needle to reduce the tensile strength of the cord. The finger is then forced straight in efforts to ‘break’ the cord. The patient and clinician can often hear the pop or snap as the cord breaks, and the finger is moved through passive range of motion to ensure the cord has been broken. Typically, the most successful cases of a needle aponeurotomy occur in the early stages of the disease. There has been some success with more advanced stages, although recurrence of cord formation after several years is often seen.
More advanced stages of Dupuytren’s disease involve the finger being contracted at different joints in the hand and fingers. Our next blog will discuss the progression of Dupuytren’s disease, as well as surgical options, and post-operative management.
Riki Duncan, ATC, LAT